Adrenal
leiomyosarcomas are rare mesenchymal
tumors of the suprarenal region that are usually diagnosed after they have reached a large size. We report the case of a 62-year-old male with an incidentally found left adrenal mass. Magnetic resonance imaging of the retroperitoneal space showed a heterogeneously enhanced mass, measuring 10x8.2 cm, with characteristics suspicious of
malignancy. The patient underwent left radical
adrenalectomy after the hormonal evaluation of the
tumor due to the high probability of
adrenocortical carcinoma. However, microscopic examination of the
tumor showed a
spindle cell sarcoma. Immunohistochemically the neoplastic cells were found positive for
desmin and smooth muscle actin and the diagnosis of a well differentiated adrenal
leiomyosarcoma was established. During follow-up the patient presented an aggressive course as he developed bone, liver and pulmonary
metastases early postoperatively, which were treated with
radiation therapy and
chemotherapy. The patient has progressive metastatic disease while on
chemotherapy 31 months after surgery.